Policy Updates May 2014

The information outlines updates to policies that are effective this month. To view the updated policy in its entirety, select the policy name.

Policy Name Affected Physicians Updates Effective Date
Neuropsychological Testing
  • Family medicine physicians
  • Neurologists
  • Pediatricians
  • Psychologists
  • Sports medicine physicians
  • With this update, we will no longer cover neuropsychological testing when used for testing concussions.
  • This includes the following CPT ® and diagnosis codes:
    • CPT codes: 96116, 96118, 96119, 96120
    • Diagnosis codes: 850.11, 850.12, 850.2, 850.3, 850.4, 850.5
  • 05/19/2014

Positron Emission Tomography

  • Anesthesiologists
  • Hematologists
  • Internal medicine physicians
  • Oncologists
  • Radiologists
  • With this update, we will no longer cover PET scans when used for the treatment of hepatobiliary, renal (kidney), and prostate cancer.
  • This includes the following CPT ® and diagnosis codes:
    • CPT codes: 78811, 78812, 78813, 78814, 78815, 78816
    • Diagnosis codes: 155.0, 155.1, 155.2, 156.0, 156.1, 156.2, 156.8, 156.9, 185, 189.0, 189.1, 189.8, 197.7, 197.8, 198.0

    *Please note that this policy is managed by MedSolutions, Inc.
  • 05/19/2014

The appearance of an item or procedure in this update indicates only that we have recently adopted or revised a policy. It does not imply that we provide coverage for the items or procedures listed. In the event of an inconsistency or conflict between the information provided below and the posted policy, the provisions of the posted policy will prevail.